Can You Be Depressed Without Knowing It? I Was

Even when we know what depression looks like, we can miss it in ourselves.

Much of my work as a clinical psychologist has focused on treating individuals with depression, so I've learned a lot about what it looks like. And yet when I gradually slipped into my own state of depression some years ago, I didn't recognize it.

Over time, I had developed the telltale symptoms, including a pervasively negative view of myself as a "loser." In hindsight, it's obvious that I was thinking like a depressed person, but at the time I believed the self-loathing thoughts. Finally, I recognized that they were being driven by my mood.

My experience could be chalked up to "another psychologist without self-awareness," and yet I don't believe that tells the full story. Many people I've treated have described a similar blindness to their own depression, until it became unmistakable.

Even the people we're closest to might not realize we're depressed, especially if we're good at "soldiering on." They may sense we're not at our best, but might attribute it to other factors.

Given the greater public awareness of depression — and professional experience in my case — how is it possible to not know when it's present? There are several factors that can play a role:

1. Depression can look really different from person to person.

Two people who are both depressed might have zero symptoms in common. Robin, for example, might feel really low, have insomnia, be unable to eat more than a few bites at a time, struggle with concentration, and be so miserable she's considering ending her own life. Terry, on the other hand, doesn't feel noticeably down, but has no interest in anything, even activities he used to enjoy. He's sleeping 12 hours a day, but is still fatigued and physically slowed, and feels completely worthless. As different as these two examples are, they both are consistent with major depressive disorder. The severity of depression can vary a lot, too, from being completely unable to function to still being able to take care of one's responsibilities and even find occasional enjoyment. We're less likely to see milder forms of depression for what they are.

2. Depression tends to develop gradually.

The development of each symptom of depression can be like hair growing, with no noticeable change day to day or even week to week. Since we're never not with ourselves, we may not have a good sense of small changes over time as our mood, energy, and view of ourselves dip. And then one day, we might finally look at ourselves and barely recognize the person we see, as the cumulative changes become obvious.

3. In a related way, the various symptoms of depression often develop at different times.

Depression often has an insidious onset — we develop a symptom here, a symptom there. We might not have as much energy as before, and a few weeks later we notice that we're crankier than usual. We might not suspect that both experiences are connected to the same underlying condition. If several depression symptoms landed in your life all at once, it would be much more obvious that they were part of a syndrome.

4. There may be an obvious reason for feeling down.

When we're facing major challenges like health problems, a painful divorce, or job loss, we expect to feel poorly. It would be strange, in fact, if our moods weren't affected to some extent. Thus we might not call our reaction "depression," because it seems so understandable. However, these kinds of losses are among the most consistent predictors of depression, as we lose reliable sources of reward, engagement, and support.

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5. There may be no obvious “reason” to be depressed. On the other hand, our moods can tank without any cause that we can identify. It could be that we have a genetic predisposition to depression, or that we're sensitive to seasonal shifts. There could also be identifiable changes in our lives that could account for our low mood, but we don't make the connection. For example, we may have gotten a better job, which we expect would improve our mood; however, we also left behind a solid group of friends at our old job, and now have a stressful commute in the car whereas before we could take the train. Without an obvious trigger for our depression, we’re less likely to see it when it comes.

6. Some symptoms might not seem like depression.

We often assume that a person who's depressed is really sad, and yet depression doesn't have to include sadness. Many individuals with depression feel more numb than sad, or may have lost interest in things they used to enjoy without having an obvious shift in their emotional state. It can also be easy to attribute depression symptoms to other factors, since depression is one of several possible explanations. For example, we might blame stress for our increased appetite and sleep problems, and think our trouble concentrating is driven by poor sleep.

7. We don’t want to see ourselves as "depressed."

Despite progress over the past few decades, there is still a lot of stigma around depression. We may have internalized that stigma, seeing depression as a "weakness" or "personal failure." As a result, we might not want to recognize our own depression. Maybe we prided ourselves on our strength and resilience, and depression just doesn’t square with our identity. We may therefore look for any alternative explanation for the way we're feeling.

How Recognizing Depression Helps

Coming to see our depression for what it is can be tremendously helpful, even life-changing, in at least two ways.

First, depression can affect all areas of our life, making us feel like everything is falling apart: We're not sleeping well, we're irritable, our motivation is gone, nothing is fun anymore, and so forth. Putting these many struggles under a single umbrella makes them much more manageable. Rather than having 15 problems, we have one, and obviously it's easier to tackle a single problem than 15.

For many people, depression can be managed without professional assistance, especially if the depression falls in the mild to moderate range, and if there's a low risk for self-harm. I was able to manage my own depression through a combination of self-help, strong support from the people closest to me, and getting involved in a triathlon.

If you or a loved one has been struggling and some of your symptoms could reflect depression, it may be a good idea to schedule an appointment with your primary care doctor or a mental health professional. Psychology Today offers a database where you can search for a therapist who would be a good match for you.

However we combat depression, we don’t have to suffer — help is available. And like anything else, knowing what we’re dealing with is half the battle.

Worry not, folks. 'Depression', as diagnosed by doctors (e.t.c.), is just a label. Makes life easier for the doctors. It is, possibly, their way of encouraging the 'patient' to reveal more. The good news is that you may not be depressed at all. Just dealing with extra feelings to add to those you have experienced already. There's more good news. Those extra feelings are not necessarily bad ones. They are there to help others, hopefully. Why? Well, suppose they put you in a situation you did not desire? This might cause you to be angry in the privacy of your home. Not surprising. So what you do is take steps to understand how THEY made mistakes. Then you should be on the road to recovery. Good luck.

I appreciate your thoughts, Mike. It's an important point that inactivity does not lead to feeling well. Being more physically active is consistently linked to improved mood (and yes, is about as powerful as antidepressant medication!).

That said, the data I'm aware of suggest if anything that those with blue collar jobs are *more* likely to experience depression. That is, if we assume that lower income and education are correlated with blue collar job status. If there are data showing that blue collar jobs prevent depression, I would definitely want to know about it. Thanks again.

As I'm sure I'm preaching to the choir, correlation does not imply causation. I think drugs and alcohol abuse have to be factored in, plus bad marriages, life choices.

I have both blue and white collar friends, both groups seem to be equally weighted with their personal issues. But my blue collar friends seem to work more and have less time for "nonsense," where my white collar friends have a lot of idle time on the weekends. They also seem to try and fill that time with creative hobbies, but it doesn't seem to help them to stop dwelling on all the issues in their lives.

That said, I train martial arts with a full range of men and women on the weekend--which is like a tough job--and these people seem to be the happiest and most grounded people I know.

My guess is, if you're going to do something to take your mind off of life's pressures, do something that causes pain and extreme exhaustion. Haha!

Mike, these are all excellent points. It reminds me of times when I was spending hours in front of a computer screen, alone, working on research papers that seemed to have very little real-world relevance. My mood was never great at the end of those days! Training for triathlons was such a welcome contrast—being outdoors, sweating, using my body, seeing progress.... I can't imagine that more cerebral hobbies would have helped nearly as much.

I also agree that too much idle time can set us up for "getting in our heads" in an unhelpful way. (On the other hand, never having a moment to stop and exhale usually isn't a recipe for happiness....)

These things underscore how important it is to notice not only what our moods are up to but the activities that seem to lead to better and worse mood. We often seem to be drawn to things like inactivity that are easy in the moment but don't lead to feeling our best!

Seth J. Gillihan PhD refers to 'real-world relevance'. Interesting that the word 'relevance' is in the same phrase. Here's something that might be worth considering: People use the phrase 'real-world' (or realities) because of how they felt about the world previously when it was supposed to be 'good and true'. Therefore, people also tend to use the word 'relevance' to indicate how they felt earlier. I can mention moments that I might not have wanted but those moments did not persuade me to use words like 'real-world' and / or 'relevance' in such a way that it would have been obvious to others. I decided to investigate those moments (mentioned earlier) as a way of understanding how others can function in their everyday lives. I'd hesitate, for personal reasons, to eagerly use the word 'spirituality' but extra comfort can be gained from analysis situations that may arise. That's if.......er.......you've got time for it. If not, then making time for it should be regarded as essential.

As a psychologist, I consider this article pretty interesting. As it it is mentioned, it is difficult for each person to identify some symptoms or those symptoms can be assumed that are related to something else or a particular situation going through.

And it's much more difficult to be aware or conscious of a symptom without the knowledge of the various symptoms that depression has (and not only depression, same with other disorders).

I would like to say that, despite the fact that there are a large number of research regarding mental health and different psychological disorders. People tend to believe everything it's okay, and it's the common thought that being in trouble is bad, that's why a lot of people does not receive the help that it is needed.

Also, maybe it is job for health and mental health institution to create awareness and motivate people to ask for help when it's needed.

I think I have probably had dysthymia my whole life due to having been raised by a mother who didn't want me or even like me, so feeling kind of like an outsider and not fitting in with others and being afraid of intimacy my whole life was my "normal". But since mother died I think I "graduated" to actual depression. It's an effort to make myself do anything at all, now, Plus my health has deteriorated. I want to feel better. I don't like puffing for air with only minor exertion and being unable to focus on anything for very long. Which depression treatment protocols have the fewest bad side-effects, if you can share that info?

Thanks for the question, Anonymous. Psychotherapy has the fewest side effects, though of course it can be a lot of hard work. If you google "APA Division 12 depression treatments" you'll find a list of treatments that have been shown to be effective in treating depression. (The system doesn't allow for links in comments.) Among the medications for depression, SSRIs like sertraline (Zoloft) and fluoxetine (Prozac) tend to have the fewest side effects. Best wishes for your recovery.

Original question: "Can You Be Depressed Without Knowing It?" Of course you can. The subconscious mind may be very depressed while the conscious mind is putting on a smile for raw survival's sake in such a brutal world as we live in now. I remain adamant that drugs are never the answer to depression. There may have once been a genuine effort to find out what in the subconscious mind may have been making someone depressed or otherwise disaffected, but that is lost in the mists of time as mental health therapy assumed the function of jailing and lock-up for "behavioral health" and the pushing of drugs and sex as the answer to society's problems.